BJC HealthCare (BIC) and Washington University School of Medicine (WUSM) propose to study 1) the best methods to identify medical errors and how to improve reporting of medical errors and adverse events 2) the epidemiology of medical errors including the organizational, process, and human factors which contribute to the occurrence of medical errors 3) the effectiveness of educational and process interventions to reduce medical errors and improve patient safety and 4) how healthcare workers communicate with patients and families about medical errors including patients' attitudes and preferences regarding communication about medical errors. BJC is one of the largest and most diverse not-for-profit health systems in the US., with 13 acute care hospitals (including academic, community; urban, suburban, rural, and adult and pediatric hospitals), and over 100 healthcare delivery sites, with long-term care facilities, a home health agency, and a physician practice group. BJC includes two US. News and World Report "top 10" hospitals. WUSM is recognized as a leader in innovative biomedical research, and perennially ranks in the top 5 in NIH research and training grant funding and student selectivity. BJC's Cater for Healthcare Quality and Effectiveness, the Infection Control and Healthcare Epidemiology Consortium and the Patient Safety Program currently collect information on medical errors and adverse events in all BJC hospitals using a voluntary "no fault" reporting system and active surveillance. This rich database will be used to study the effectiveness of different methods of medical error surveillance and reporting, such as telephone hot lines, paper, web-based reporting, incentives etc. Medical errors will be evaluated using critical incident analysis, root cause analysis, epidemiologic methods, and organizational and systems analysis to determine factors associated with errors. These different analytic methods will be compared to determine the most effective approaches to understand and prevent medical errors. Using this information, we will develop and implement interventions to reduce medical errors using process improvement, education, and automation. We will then systematically evaluate the impact of the interventions throughout BJC. 1n addition, we will be performing specific studies to understand how health care workers communicate information on medical errors to patients and families using focus groups, surveys, and interviews.